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Cure through substitute treatments in Belgium: development of a model for assessment of types of care and patients

Research project DR/01 (Research action DR)

Persons :

Description :

1. Aims

The "Federal Policy Memorandum on drugs" (Ministry of Public Health, January 2001) gives consideration to transcribing conclusions from the Consensus Conference on substitute treatments (Ghent, 1994) into restrictive legislation. Furthermore, it specifies the fact that implementing a policy based on scientific research is the matter at hand. Indeed, the existing legal vacuum has allowed diversified practices to develop in the field that require evaluation.
The issue therefore is one of studying the various practical means of accessing substitute treatments on an out-patient basis, namely:

1) doctors, through private consultations;
2) doctors, organised into help networks;
3) out-patient departments, specialised in the assistance of drug addicts ("session centres");
4) "Medical-Social Open Centres for drug users" (MSOC) - already the subject of a detailed OSTC assessment (1.)

This project is a direct continuation of the MASS research-assessment project.

2. Programme

Three geographical areas have been designated for this research: Hainaut province (representing Wallonia), Limburg province (representing Flanders), and the Brussels-Capital Region. The programme runs from 1 August 2002 to 30 September 2003.

Task 1: Critical and comparative analysis of the legal situation and of scientific literature in Belgium, France and the Netherlands: An initial task involves taking stock of the situation as regards substitute treatments in Belgium, primarily by comparing these with the situation in other countries. The specific countries chosen for comparison purposes are France and the Netherlands on account of their geographical and cultural proximity as well as their policy orientations, which should produce two antithetic models. The analysis will summarise the rules governing therapeutic good practice and the legal frameworks currently in force.

Task 2: General inventory of doctors working in private practice who offer substitute treatments in the pilot geographical areas (Hainaut and Limburg provinces, Brussels-Capital Region): All doctors working in private practice in Hainaut and Limburg provinces and the Brussels-Capital Region are to be contacted via a questionnaire. The information compiled will identify doctors who are offering these treatments, their proportion, and the number of patients undergoing treatment with these doctors. At the same time, the inventory will compile a sample of doctors offering substitute treatments in private practice within each area.

Task 3: Quantitative and qualitative assessment of practices with substitute treatments in institutions and by doctors in private practice: This is a matter of producing a quantitative and qualitative assessment of substitute treatments within a sample of institutions and doctors.

For what concerns the quantitative approach : Collection of data on institutions through Monitoring Area Phase System (MAPS) and Treatment Unit Form (TUF).
Aims: to identify types of services, organisational processes, therapeutic methods, and inclusion/exclusion criteria to treatment. Questionnaires and databases already used in institutions will also be used as additional indicators and in order to compile random stratified patient samples.

Simultaneously and also six months further into the programme, data will be collected on these patient samples (testing - retesting) using Addiction Severity Index (ASI) ("EuropASI" in Flemish, IGT in French) and Quavisub. Aims: to investigate the medical situation, the position in terms of employment and social back-up, substance use (alcohol / drugs), the legal situation, family history, social relationship, psychiatric situation, satisfaction as regards various areas of life, relational and social interdependencies, subjective well-being, performances, subjective estimation of the level of health, and life scale.

For what concerns the qualitative approach : Intensive contact work involving institutional intervision within a global action research approach (cf. MSOC evaluation). Bi-monthly meetings with protagonists from institutions taking part in the assessment, and monthly meetings with panels of doctors.
Aims: to define, for each institution/panel, treatment aims, inclusive and exclusive factors with regard to the target populations, evaluation of therapeutic processes ("process research"), and identification of "good practice" factors within therapy.
Over the final three months of the research, Focus Groups, including representatives from institutions included in the sample and the members of panels, will be organised in each geographical area so that all actors are able to compare the results obtained via institutional intervision within each institution/panel.

Task 4: closure: Finalisation of the Focus Groups, drafting of closing reports (provisional final summary and motivation report for any possible extension), Study Day organisation.

(1.) PELC I., DE RUYVER B., CASSELMAN J., MACQUET C., NOIRFALISE A. & AL.; "Assessment of socio-medical reception centres for drug users", overall summary report, OSTC, Brussels, 2001

Documentation :

Les prises en charge par traitements de substitution en Belgique: développement d'un modèle d'évaluation des diverses filières de soins et des patients : résumé    Bruxelles : Politique scientifique fédérale, 2004 (SP1425)
[To download

Substitutiebehandeling in België: ontwikkelen van een model ter evaluatie van de verschillende types van voorzieningen en van patiënten : samenvatting    Brussel : Federaal Wetenschapsbeleid, 2004 (SP1426)
[To download

Développement d'un modèle d'évaluation des diverses filières de soins et des patients = Ontwikkelen van een model ter evaluatie van de verschillende types van voorzieningen en van de patiënten : rapport final    Brussel : Federaal Wetenschapsbeleid, 2011 (SP2449)
[To download

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